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MDMA, also known as Ecstasy or Molly, is a synthetic stimulant with hallucinogenic effects.  It was discovered in Germany in 1912 by Anton Kollisch who was working for the pharmaceutical company Merck.  MDMA was originally made to treat uterine bleeding.

MDMA (3, 4-methylenedioxy-methamphetamine)

In 1970 it came to the attention of Alexander Shulgin and David Nichols from Dow Chemical Co., who saw the potential for the drug to reduce fear in patients and increase insight.  MDMA became the drug of choice at clubs, house parties and raves.

MDMA is a Schedule 1 substance.  It is given this rating because the FDA sees no legitimate medical use for it and it has the potential for abuse and addiction.

MDMA causes the release of the neurotransmitters serotonin, norepinephrine and dopamine in the body.  The neurotransmitter serotonin plays an important part in the role of sleep, mood, pain and appetite.  When large amounts of serotonin are released while taking MDMA, it causes the brain to become depleted of this neurotransmitter and the user ends up experiencing confusion, depression, fatigue and memory problems.  MDMA can even damage the serotonin-containing neurons which could cause long-lasting damage.  Other long-term effects include irritability, impulsiveness, sleep problems, increased body temperature, decreased sexual interest and memory impairment.

Some of the short-term effects include euphoria, increased energy, distorted perception, increased heart rate, hallucinations, nausea, blurred vision, chills, and sweating.  The most dangerous short-term effects are dehydration and hyperthermia.

Combining MDMA with other substances

MDMA and Alcohol

Mixing MDMA with alcohol will put an enormous strain on the kidneys.  Heavy drinking can lead to dehydration and a worse come down from the drug.  Alcohol is often involved in MDMA related deaths.

MDMA and Cocaine

MDMA and Cocaine are both stimulants and when used alone can be life-threatening, when used together the risk is compounded.  The most serious effects are heart attacks, cardiac arrhythmias, paranoia, seizures, tremors, coma, dehydration and hyperthermia.

MDMA, Cocaine and Alcohol (A lethal combination)

When Cocaine and Alcohol are combined together they create a lethal combination called Cocaethylene in the liver.  This is a metabolite that increase the risk of heart attacks, arrhythmias and strokes and when MDMA is added to the mix the combination can be fatal.

MDMA and drug interaction

MDMA used with other serotonergic drugs can lead to a life threatening condition called Serotonin Syndrome and a severe overdose can result in death.

MDMA and Caffeine

Caffeine increases the psychostimulants in MDMA and promotes the toxicity of the amphetamines.

MDMA and treatment

Currently there are no specific medications for the treatment of MDMA dependence; however different pharmacological tools can be helpful.  There are several different sleep aids that can be prescribed to combat insomnia and anti-depressants can be used to help replenish serotonin and dopamine levels and manage depression and anxiety.  An increase in fluids will be necessary to help with dehydration, and regular, healthy balance meals are essential to correct possible weight loss and anorexia.

Psychosocial treatment

Inpatient and residential treatment centers can vary from a 30-90 day stay; treatment is intensive.  Some treatment centers can also include various forms of holistic.

Outpatient treatment can vary in length from 8 weeks – 6 months.  An outpatient program is a good option for someone who has gone through a recovery program, but still needs to gain more knowledge about addiction.

The Matrix Model in an intensive outpatient program of approx. 16 a weeks and is helpful for addiction to stimulants. This model includes relapse prevention, urine testing, self-help, therapy and family education.  A therapist plays the role of coach and fosters a positive environment and focuses on self-worth.

Cognitive Behavioral Therapy (CBT) is based on the idea that human behaviors, thoughts and feelings are interconnected.  The approach is to change unwanted behaviors and develop different coping strategies and self-monitoring practices.

Dialectical Behavior Therapy (DBT) is a cognitive behavioral treatment that helps people learn and use new skills and strategies to develop a life that they experience as worth living. DBT skills include skills for mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.

Future research

There has been some positive data to show that MDMA could be useful for individuals diagnosed with PTSD or for social anxiety in adults suffering from autism, but more research is needed to determine the benefits of MDMA as a treatment option.

References:

National Institute on Drug Abuse. (2013). MDMA (Ecstasy, Molly). Retrieved online from www.drugabuse.gov/drugsabuse/mdma-EcstasyMolly
americanaddictioncenters.org

Johnina Noar, CADC-II
AToN Center 888-535-1516